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Background Managing multiple sclerosis (MS) includes different treatment approaches. Rehabilitation is a key strategy in MS for improving functioning, activity and participation. As part of a larger study on overall patient experiences with different treatment approaches, this study aims to give an overview of different patients’ experiences and perspectives on inpatient rehabilitation in MS. Methods We conducted problem-centered interviews in 50 persons with MS in Germany, of whom most had relapsing–remitting MS. We used the maximum variation sampling method during recruitment. Data were analyzed thematically. Results As a result of the analysis, three major themes were identified: 1) factors contributing to the decision-making concerning rehabilitation, 2) experience with the rehabilitation setting, 3) benefits of rehabilitation treatments. The treating physicians’ attitude had a major impact on the decision to either opt for rehabilitation or not. Setting goals prior to rehabilitation was given a high priority. Exchanging experiences with other persons with MS presented a major benefit from rehabilitation while for some being separated from regular daily life resulted in a more ambiguous attitude ranging from appreciation of escaping daily hassles to substantial behavioral change management. Conclusion Patients reported various experiences in the process of decision-making with regard to rehabilitation. Physicians´ advice, goal setting and the selection of the most suitable rehabilitation clinic were considered most relevant.

Background Besides coping with a disease with many uncertainties, people with relapsing-remitting multiple sclerosis face complex decisions concerning disease-modifying therapies (DMTs). In an interview study, we aimed to assess patients’ experiences with DMTs. Methods Problem-centred interviews were conducted with 50 people with relapsing-remitting multiple sclerosis in Germany using maximum variation sampling and covering all licensed DMTs. Data were analysed thematically using deductive and inductive categories. Results 47 of 50 patients had treatment with at least one of the approved DMTs. The main themes were: (1) starting a DMT, (2) switching to another DMT, (3) discontinuing a DMT, and (4) multiple sclerosis without starting a DMT. Different intercorrelated factors influenced the decision-making processes for or against a DMT. Individual experiences with DMTs in daily life contained the effort in administration, success, and failure of DMTs, coping strategies and well-being without DMTs. The decision-making process for or against a DMT and the use of those treatments can be understood as a constant, continually shifting process, complicated by different factors, which change over time. Experiences with DMTs were characterized by attempts to handle uncertainty and to (re)gain control and integrate adaptivity into one’s life. Conclusions The study provides a rich and nuanced amount of patients’ experiences with DMTs. The findings demonstrate the importance for practitioners to look at current life circumstances of patients with multiple sclerosis when recommending a DMT and to promote and enable patients to make informed decisions.

Background A variety of management options (e.g., disease-modifying therapy, lifestyle interventions, rehabilitation) are available for persons with relapsing-remitting multiple sclerosis (MS). Besides coping with the diagnosis, persons with MS have to make complex decisions, e.g., regarding disease-modifying therapies. In addition to factual information, reports of patient experiences may support other patients in their decision-making. Therefore, we developed a website presenting patient experiences illustrated by video, audio and text files. This study aimed to test the acceptability and usability of a website with patient experiences with MS. Methods A mixed-methods approach was applied. A total of 69 participants visited the German “Patient Experiences with MS (PExMS)” website and among them, 50 persons with MS and 6 experts completed an online survey. In total, 18 participants took part in telephone interviews or focus groups. Data from the survey were analysed using descriptive statistics. Qualitative data were analysed using thematic analysis. Results Both quantitative and qualitative responses suggest that the PExMS website was viewed positively by patients and experts. 94% of persons with MS agreed that the information was comprehensible and reliable. 54% felt encouraged to share their health problems with others after having studied the website. 74% claimed to use the website if they had to make a decision regarding their health. Qualitative responses deduced from the website fell into 5 key themes: (1) web design, appearance, and functionality, (2) content, (3) usability, (4) satisfaction, and (5) loyalty. The search for persons of similar age and with comparable experiences was a major driving force to navigate the website. The material on the website was perceived as diverse, covering both positive and negative experiences in daily living with MS. All participants greatly appreciated having access to other people’s experiences online and judged the material on the website as particularly helpful in decision-making for disease-modifying therapies. Conclusions The findings suggest that the PExMS website might have the potential to be a useful source of audio-visual information for persons with MS. Given the lack of websites available to patients with experiential information, health care professionals may be encouraged to routinely inform patients about this website at regular appointments.

We studied the relationship between adrenal weight and postmortem cortisol level in cases of infant death, and examined use of these measurements in adrenal insufficiency. We analyzed procurator-fiscal postmortem reports in the West of Scotland over a three year period. Combined adrenal weight was expressed as percentage of total body weight (%TBW). Of 106 cases, median (5th, 95th) %TBW was 0.056 (0.025, 0.23) and median plasma cortisol was 8.4 ug/dl (1.0, 47.1). There was no correlation between %TBW and plasma cortisol (r = 0.09, p = 0.4). The lowest and highest plasma cortisol quartile had medians of 1.9 ug/dl (1.0, 3.4) and 34.3 ug/dl (17.3, 71.5), respectively. Infection was present in 6 cases (23.1%) in the lowest quartile and in 16 cases (61.5%) in the highest quartile (p = 0.01). Our results highlight the difficulty in interpretation of cortisol at postmortem and suggest that adrenal weight measurement alone may be insufficient for diagnosis of adrenal insufficiency.

The implementation of genre theory in the business communication classroom could lead to the cultivation of critical thinking skills in students. The lack of a common definition of critical thinking skills across academia and the workplace creates a difficult end goal to pursue; therefore, teachers should consider explicitly teaching to the outcome, or telos, of critical thinking through genre. This article examines a small corner of genre theory, identifies a genre theory framework for business communication, and discusses the implications of such a framework.

This article develops an approach to establishing university pro bono (UPB) programmes in developing legal jurisdictions. First, through comparative research and surveying of pro bono programmes in the United Kingdom, Australia and Canada, factors which affect the development of UPB programmes are identified. Second, the authors explore the applicability of different pro bono programme structures and project types, given available resources, supervisory capacity and student participation in the context of developing legal jurisdictions. It was found that limited financial resources or internal or external managerial support does not in itself prohibit the establishment, development or sustainability of UPB programmes. Instead, it simply influences the choice of programme structure and types of projects which can be successfully undertaken. In conclusion, the article advocates for a context appropriate ‘adaptation’ of UPB programme structures and projects as opposed to direct transplantation. Pro bono culture, perceptions of student capability and local context are all key factors which will affect the development of UPB and the types of projects that can be undertaken. Subject to these factors, it was found that legal research and community legal education projects are generally the most appropriate types of projects to run where resources are limited.

The objective of this study was to determine the physiochemical characteristics and sensory quality of smoked, coarse-ground catfish sausages and catfish frankfurters by using 100% fillets, 75% fillets with 25% nuggets, and 50% fillets with 50% nuggets (the proportions of fillets and nuggets equaled 100% for each of the three formulations). Pork fat was added to each formulation to bring the final fat content to 20%. Lightness (L*) decreased (p 0.05) by catfish fillet percentage but were affected (p 0.05) in consumer acceptability among frankfurter samples, with all samples receiving average scores between “like moderately” a...

A volume‐regulated anion channel (VRAC) has been electrophysiologically characterized in innumerable mammalian cell types. VRAC is activated by cell swelling and mediates the volume regulatory efflux of Cl− and small organic solutes from cells. Two groups recently identified the mammalian leucine‐rich repeat containing protein LRRC8A as an essential VRAC component. LRRC8A must be coexpressed with at least one of the other four members of this gene family, LRRC8B‐E, to reconstitute VRAC activity in LRRC8 −/− cells. LRRC8 genes likely arose with the origin of chordates. We identified LRRC8A and LRRC8C‐E orthologs in the zebrafish genome and demonstrate that zebrafish embryo cells and differentiated adult cell types express a swelling‐activated Cl− current indistinguishable from mammalian VRAC currents. Embryo cell VRAC currents are virtually eliminated by morpholino knockdown of the zebrafish LRRC8A ortholog lrrc8aa. VRAC activity is fully reconstituted in LRRC8 −/− human cells by coexpression of zebrafish lrrc8aa and human LRRC8C cDNAs. lrrc8aa expression varies during zebrafish embryogenesis and lrrc8aa knockdown causes pericardial edema and defects in trunk elongation and somatogenesis. Our studies provide confirmation of the importance of LRRC8A in VRAC activity and establish the zebrafish as a model system for characterizing the molecular regulation and physiological roles of VRAC and LRRC8 proteins.

The signaling mechanisms that regulate CLC anion channels are poorly understood. Caenorhabditis elegans CLH-3b is a member of the CLC-1/2/Ka/Kb channel subfamily. CLH-3b is activated by meiotic cell-cycle progression and cell swelling. Inhibition is brought about by GCK-3 kinase-mediated phosphorylation of S742 and S747 located on a ∼176 amino acid disordered domain linking CBS1 and CBS2. Much of the inter-CBS linker is dispensable for channel regulation. However, deletion of a 14 amino acid activation domain encompassing S742 and S747 inhibits channel activity to the same extent as GCK-3. The crystal structure of CmCLC demonstrated that CBS2 interfaces extensively with an intracellular loop connecting membrane helices H and I, the C-terminus of helix D, and a short linker connecting helix R to CBS1. Point mutagenesis of this interface identified two highly conserved aromatic amino acid residues located in the H-I loop and the first α-helix (α1) of CBS2. Mutation of either residue to alanine rendered CLH-3b insensitive to GCK-3 inhibition. We suggest that the dephosphorylated activation domain normally interacts with CBS1 and/or CBS2, and that conformational information associated with this interaction is transduced through a conserved signal transduction module comprising the H-I loop and CBS2 α1.

One of the pressing needs in the treatment of substance use disorders is the identification of adjunctive services or interventions that can be added to “treatment as usual” to improve outcomes. At this point, there is evidence that the provision of services to address psychiatric, family, employment, and housing problems can bring about improvements in these areas, and in some cases, in substance use outcomes (Friedmann, Hendrickson, Gerstein, & Zhang, 2004; McLellan et al., 1997, 1998; O'Farrell, Choquette, & Cutter, 1998). Continuing care, which serves to extend the duration of treatment, has also been shown to improve substance use outcomes (McKay, 2005). However, it can be difficult to deliver adjunctive interventions to patients in standard outpatient treatment due to the high drop out rates in these programs. For example, recent data from a national survey of addictions treatment programs indicated that the median length of stay in intensive outpatient programs was 46 days, with only 36% of admissions completing treatment (SAMHSA, 2008). One intervention that has shown considerable promise as a means to both increase retention and improve substance use outcomes is contingency management (CM), which provides incentives linked to performance. CM interventions, most notably in the form of voucher-based reinforcement therapy (VBRT) for abstinence, have demonstrated efficacy in the treatment of substance use disorders, as documented in several recent meta-analyses (Dutra, Stathopoulou, Basden, Leyro, Powers, & Otto, 2008; Lussier, Heil, Mongeon, Badger, & Higgines, 2006, Prendergast, Podus, Finney, Greenwell, & Roll, 2006). Notably, CM interventions have also proved effective in community settings (Petry, Alessi, Marx, Austin, & Tardif, 2005; Petry, Alessi, & Hanson, 2007). The majority of trials utilizing CM for drug abstinence have focused on initiating abstinence early in treatment. What has been much less frequently addressed is whether CM works as an adjunctive relapse prevention intervention in individuals who have achieved initial engagement in treatment and already sharply reduced or stopped using drugs. Another intervention that, at least theoretically, should promote better outcomes in initially stabilized patients with substance use disorders is relapse prevention, or RP (Marlatt & Gordon, 1985). Most RP interventions make use of techniques from cognitive-behavioral and social skills therapies to increase awareness of situations in which the individual has been particularly likely to use drugs (i.e., “high risk situations”) and improve coping responses for these situations through rehearsal and homework assignments (Annis & Davis, 1989; Carroll, 1998; Marlatt & Gordon, 1985). Improvements in these areas are thought to increase self-efficacy, which in term promotes further improvements in coping abilities. Although CBT-based interventions are widely seen as evidence-based (Carroll, 1996), recent research has suggested they are not more effective than other bona fide treatments for substance use disorders, whether delivered as a primary treatment or as a form of continuing care (Dutra et al., 2008; Irvin, Bowers, Dunn, & Wang, 1999; Longabaugh & Morgenstern, 1999; McKay et al., 1999; McKay, Lynch, Shepard, & Pettinati, 2005; Morgenstern & McKay, 2007; Rawson et al., 2006). Therefore, it is not clear that supplementing standard addiction treatment with RP for patients who have achieved initial engagement will in fact lead to better outcomes. There is also mixed evidence regarding possible additive effects for interventions that combine RP/CBT and CM over RP/CBT or CM alone. Epstein, Hawkins, Covi, Umbricht, and Preston (2003) reported that CM alone was more effective in decreasing cocaine use in methadone maintenance patients than CM+CBT during treatment, but additive effects favoring the CM+CBT condition over CM alone emerged at 12 months. Shoptaw et al. (2005) found that methamphetamine dependent participants had better drug use outcomes in CM+CBT than in CBT alone, but the combination condition was not more effective than CM alone. Finally, in studies with methadone maintenance and methamphetamine dependent patients, Rawson and colleagues found that while shorter term outcomes favored CM over CBT or control conditions, longer term outcomes in CBT conditions were not different from those in CM conditions. Moreover, there were no additive effects for CM+CBT over CM or CBT (Rawson et al., 2002; Rawson et al., 2006). It should be noted that all of these studies were done as abstinence-initiation projects, rather than as continuing care or relapse prevention projects. Another important consideration in the selection of adjunctive interventions to reduce relapse in stabilized patients is whether the effects of the intervention persist into the post-treatment period. There is some evidence that RP/CBT interventions can exhibit sleeper effects, where the positive effects of the intervention in relation to comparison conditions does not become apparent until after the interventions are over (Carroll et al., 1994; McKay et al., 1999; Rawson et al., 2002; Rawson et al., 2006), although this is not the case in all studies. Until recently, most studies of CM did not have post-treatment follow-ups. However, a number of newer studies have included post-treatment follow-ups, usually out to 12 months. The results have been mixed, with some studies showing evidence of sustained voucher effects (Alessi, Hanson, Wieners, & Petry, 2007; Epstein et al., 2003; Higgins, Wong, Badger, Ogden, & Dantona, 2000; Higgins et al., 2003; Higgins et al., 2006), and other studies showing no sustained effects (Milby et al., 2003; Petry et al., 2005; Petry et al., 2006; Rawson et al., 2002; Rawson et al., 2006; Shoptaw et al., 2005). This paper presents results from a program of research on the effectiveness of enhancements to improve continuing care in outpatient specialty care for drug and alcohol dependence. Participants were recruited from cocaine-dependent patients attending a publicly funded intensive outpatient program (IOP) in Philadelphia, who had successfully engaged in IOP for at least two weeks and met other study inclusion criteria. They also reported that they had been abstinent for an average of 44 consecutive days at entrance into the study, although abstinence was not a requirement for participation. The study featured a 2 × 2 design, which crossed contingency management (CM; yes/no) with relapse prevention (RP; yes/no). The CM protocol used in the study was modeled after the protocol developed by Silverman et al. (1996), which in turn was adapted from work by Higgins and colleagues (1993). Participants earned vouchers for cocaine-free urines on an escalating schedule over a 12 week period, with a total maximal value of $1,150 if all urines were cocaine-free. The vouchers could be redeemed for goods and services consistent with recovery. The cognitive-behavioral RP protocol (Annis & Davis, 1989) was delivered in up to 20 weekly individual sessions. Participants in the condition that provided both CM and RP were required to be attending their RP sessions for the first 12 weeks in order to be eligible to participate in the CM procedures during that time. The primary goal of the study was to determine whether providing CM, RP, or the combination of CM and RP to participants who had achieved initial engagement in intensive outpatient treatment would produce better cocaine use outcomes than treatment as usual (TAU) over an 18 month follow-up period. We predicted that significant main effects for CM and RP would be obtained, and the best outcomes would be found in the CM+RP condition. These predictions were tested through an examination of main and interaction effects in the 2 × 2 design and post hoc contrast analyses that compared the four treatment conditions.

Changes in phosphorylation regulate the activity of various ClC anion transport proteins. However, the physiological context under which such regulation occurs and the signaling cascades that mediate phosphorylation are poorly understood. We have exploited the genetic model organism Caenorhabditis elegans to characterize ClC regulatory mechanisms and signaling networks. CLH-3b is a ClC anion channel that is expressed in the worm oocyte and excretory cell. Channel activation occurs in response to oocyte meiotic maturation and swelling via serine/threonine dephosphorylation mediated by the type I phosphatases GLC-7α and GLC-7β. A Ste20 kinase, germinal center kinase (GCK)-3, binds to the cytoplasmic C terminus of CLH-3b and inhibits channel activity in a phosphorylation-dependent manner. Analysis of hyperpolarization-induced activation kinetics suggests that phosphorylation may inhibit the ClC fast gating mechanism. GCK-3 is an ortholog of mammalian SPAK and OSR1, kinases that bind to, phosphorylate, and regulate the cell volume–dependent activity of mammalian cation-Cl− cotransporters. Using mass spectrometry and patch clamp electrophysiology, we demonstrate here that CLH-3b is a target of regulatory phosphorylation. Concomitant phosphorylation of S742 and S747, which are located 70 and 75 amino acids downstream from the GCK-3 binding site, are required for kinase-mediated channel inhibition. In contrast, swelling-induced channel activation occurs with dephosphorylation of S747 alone. Replacement of both S742 and S747 with glutamate gives rise to kinase- and swelling-insensitive channels that exhibit activity and biophysical properties similar to those of wild-type CLH-3b inhibited by GCK-3. Our studies provide novel insights into ClC regulation and mechanisms of cell volume signaling, and provide the foundation for studies aimed at defining how conformational changes in the cytoplasmic C terminus alter ClC gating and function in response to intracellular signaling events.

Although effective goal-setting is universally accepted as good social work practice, students often struggle with establishing well-formed goals. Therefore, the authors have developed an educational approach to engage students in learning the skills of effective goal-setting. This manuscript presents a conceptual approach and instructional activities to prepare practitioners to establish well-formed goals, engage in goal-focused actions, and evaluate goal attainment.

This study examined changes among graduate students (N=52) in perception of social worker empowerment and commitment to client empowerment through social justice advocacy. Pre-post data showed that most entering MSW students possessed important beliefs about empowerment for themselves as social workers and for members of oppressed population groups. During their graduate education, significant positive change occurred in both aspects of empowerment, and social worker empowerment and commitment to client empowerment were positively associated. Belief in a just world has a significant, positive effect on worker empowerment, and an internal locus of control is associated with social worker empowerment and commitment to client empowerment.

CLH-3b is a Caenorhabditis elegans ClC anion channel that is expressed in the worm oocyte. The channel is activated during oocyte meiotic maturation and in response to cell swelling by serine/threonine dephosphorylation events mediated by the type 1 phosphatases GLC-7α and GLC-7β. We have now identified a new member of the Ste20 kinase superfamily, GCK-3, that interacts with the CLH-3b COOH terminus via a specific binding motif. GCK-3 inhibits CLH-3b in a phosphorylation-dependent manner when the two proteins are coexpressed in HEK293 cells. clh-3 and gck-3 are expressed predominantly in the C. elegans oocyte and the fluid-secreting excretory cell. Knockdown of gck-3 expression constitutively activates CLH-3b in nonmaturing worm oocytes. We conclude that GCK-3 functions in cell cycle– and cell volume–regulated signaling pathways that control CLH-3b activity. GCK-3 inactivates CLH-3b by phosphorylating the channel and/or associated regulatory proteins. Our studies provide new insight into physiologically relevant signaling pathways that control ClC channel activity and suggest novel mechanisms for coupling cell volume changes to cell cycle events and for coordinately regulating ion channels and transporters that control cellular Cl− content, cell volume, and epithelial fluid secretion.

Psychological distress among college students represents a serious health concern. The aim of this research was to investigate, for the first time, whether interactions between rumination and different measures of stress could differentially predict components of psychological distress, within a diathesis-stress framework. This self-report study employed a longitudinal design, spanning a period of 6 months. One hundred sixty-one undergraduate college students completed selected measures of psychological distress, rumination, and stress at two time points 6 months apart. Both independent and interaction effects were examined through hierarchical regression analyses. Rumination and stress were found to interact significantly to predict the social dysfunction components of psychological distress. Other main effects are reported. The evidence supported the proposed diathesis-stress model and extended previous research by relating rumination to different components of psychological distress prospectively.

This study of continuing care for substance dependent patients compared a telephone-based monitoring and brief counseling intervention (TEL) with 2 face-to-face interventions, relapse prevention (RP) and standard 12-step group counseling (STND). The participants were graduates of intensive outpatient programs who had current dependence on alcohol and/or cocaine. Self-report, collateral, and biological measures of alcohol and cocaine use were obtained over a 12-month follow-up. The treatment groups did not differ on abstinence-related outcomes in the complete sample (N = 359) or on cocaine use outcomes in participants with cocaine dependence (n = 268). However, in participants with alcohol dependence only (n = 91), TEL produced better alcohol use outcomes than STND on all measures examined and better outcomes than RP on some of the measures.

The ability to control osmotic balance is essential for cellular life. Cellular osmotic homeostasis is maintained by accumulation and loss of inorganic ions and organic osmolytes. Although osmoregulation has been studied extensively in many cell types, major gaps exist in our molecular understanding of this essential process. Because of its numerous experimental advantages, the nematode Caenorhabditis elegans provides a powerful model system to characterize the genetic basis of animal cell osmoregulation. We therefore characterized the ability of worms to adapt to extreme osmotic stress. Exposure of worms to high-salt growth agar causes rapid shrinkage. Survival is normal on agar containing up to 200 mM NaCl. When grown on 200 mM NaCl for 2 wk, worms are able to survive well on agar containing up to 500 mM NaCl. HPLC analysis demonstrated that levels of the organic osmolyte glycerol increase 15- to 20-fold in nematodes grown on 200 mM NaCl agar. Accumulation of glycerol begins 3 h after exposure to hypertonic stress and peaks by 24 h. Glycerol accumulation is mediated primarily by synthesis from metabolic precursors. Consistent with this finding, hypertonicity increases transcriptional expression of glycerol 3-phosphate dehydrogenase, an enzyme that is rate limiting for hypertonicity-induced glycerol synthesis in yeast. Worms adapted to high salt swell and then return to their initial body volume when exposed to low-salt agar. During recovery from hypertonic stress, glycerol levels fall rapidly and glycerol excretion increases approximately fivefold. Our studies provide the first description of osmotic adaptation in C. elegans and provide the foundation for genetic and functional genomic analysis of animal cell osmoregulation.

CLH-3 is a meiotic cell cycle-regulated ClC Cl− channel that is functionally expressed in oocytes of the nematode Caenorhabditis elegans. CLH-3a and CLH-3b are alternatively spliced variants that have identical intramembrane regions, but which exhibit striking differences in their N- and C-termini. Structural and functional studies indicate that N- and C-terminal domains modulate ClC channel activity. We therefore postulated that alternative splicing of CLH-3 would alter channel gating and physiological functions. To begin testing this hypothesis, we characterized the biophysical properties of CLH-3a and CLH-3b expressed heterologously in HEK293 cells. CLH-3a activates more slowly and requires stronger hyperpolarization for activation than CLH-3b. Depolarizing conditioning voltages dramatically increase CLH-3a current amplitude and induce a slow inactivation process at hyperpolarized voltages, but have no significant effect on CLH-3b activity. CLH-3a also differs significantly in its extracellular Cl− and pH sensitivity compared to CLH-3b. Immunofluorescence microscopy demonstrated that CLH-3b is translationally expressed during all stages of oocyte development, and furthermore, the biophysical properties of the native oocyte Cl− current are indistinguishable from those of heterologously expressed CLH-3b. We conclude that CLH-3b carries the oocyte Cl− current and that the channel probably functions in nonexcitable cells to depolarize membrane potential and/or mediate net Cl− transport. The unique voltage-dependent properties of CLH-3a suggest that the channel may function in muscle cells and neurones to regulate membrane excitability. We suggest that alternative splicing of CLH-3 N- and C-termini modifies the functional properties of the channel by altering the accessibility and/or function of pore-associated ion-binding sites.

This paper, part of a broader effort to construct an analytical approach that can be used to assess near-term ethnic conflict potential in different parts of the world, examines the possibility of such conflict in China. More specifically, the authors employ a theory of measurement based on subjective judgment and pairwise comparison to quantify the factors likely to produce interethnic strife, encompassing the notion that, in most cases, ethnic conflict is driven by competition over territory. Five potential ethnic fracture zones are identified, described, and mapped. Journal of Economic Literature, Classification Numbers: I31, J15, Z00. 6 figures, 1 appendix (4 tables), 51 references.

This study examined the relation between depression diagnoses and outcomes in 132 cocaine-dependent patients who were randomized to relapse prevention (RP) or standard 12-step focused group continuing care and followed for 2 years. Depressed patients attended more treatment sessions and had more cocaine-free urines during treatment than participants without depression, but they drank alcohol more frequently before treatment and during the 18-month posttreatment follow-up. Cocaine outcomes in depressed patients deteriorated to a greater degree after treatment than did cocaine outcomes in patients without depression, particularly in patients in RP who had a current depressive disorder at baseline. The best alcohol outcomes were obtained in nondepressed patients who received RP. The results suggest that extended continuing care treatment may be warranted for cocaine-dependent patients with co-occurring depressive disorders.

Pesso Boyden System Psychomotor Therapy (Psycho-motor) is offered as a useful approach to treating Dissociative Identity Disorder. Originally developed for group work, this therapy can be modified so that the alters can learn to play roles for one another that promote resolution of childhood injury, enhance internal communication and cooperation, and ultimately support the prospect of integration. Psycho-motor is unique in that it helps in the creation of synthesizing memories that provide antidotes for early traumas; not only can childhood abuse and neglect be metabolized, but also images of needs being met can be added. Moreover, Psychomotor develops the “Pilot” or adult functioning so that there is less likelihood of regression or dependence on the therapist. A four-stage progression of treatment is outlined: development of the “Pilot,” teaching the system's adults to engage in parenting the child alters, healing the wounds and the defensiveness of the “Protector/Controller,” and the internali...

This article examines the amount of writing on gay and lesbian subject matter in 12 social work journals and two gay and lesbian journals 1988-1997. Two-thirds of the 121 social work journal articles published on homosexuality focus on HIV/AIDS. Gay and lesbian subject matter not related to HIV/AIDS constitutes only 1 % of this literature. Meeting the Council on Social Work Education requirement for curriculum content on sexual orientation will be difficult if educators rely only on social work journals for knowledge. The publication record for articles on homosexuality in the 12 journals under study must be strengthened.

K-Cl cotransporters (KCC) play fundamental roles in ionic and osmotic homeostasis. To date, four mammalian KCC genes have been identified. KCC2 is expressed exclusively in neurons. Injection of Xenopus oocytes with KCC2 cRNA induced a 20-fold increase in Cl−-dependent, furosemide-sensitive K+uptake. Oocyte swelling increased KCC2 activity 2–3 fold. A canonical tyrosine phosphorylation site is located in the carboxy termini of KCC2 (R1081–Y1087) and KCC4, but not in other KCC isoforms. Pharmacological studies, however, revealed no regulatory role for phosphorylation of KCC2 tyrosine residues. Replacement of Y1087 with aspartate or arginine dramatically reduced K+uptake under isotonic and hypotonic conditions. Normal or near-normal cotransporter activity was observed when Y1087 was mutated to phenylalanine, alanine, or isoleucine. A tyrosine residue equivalent to Y1087 is conserved in all identified KCCs from nematodes to humans. Mutation of the Y1087 congener in KCC1 to aspartate also dramatically inhibited cotransporter activity. Taken together, these results suggest that replacement of Y1087 and its congeners with charged residues disrupts the conformational state of the carboxy terminus. We postulate that the carboxy terminus plays an essential role in maintaining the functional conformation of KCC cotransporters and/or is involved in essential regulatory protein-protein interactions.

Efflux of intracellular organic osmolytes to the external medium is a ubiquitous response to cell swelling. Accumulating evidence indicates that volume regulatory loss of structurally unrelated organic osmolytes from cells is mediated by a relatively nonselective volume-sensitive anion channel. In C6 cells, we have termed this channel VSOAC for volume-sensitive organic osmolyte-anion channel. Swelling-induced activation of VSOAC required the presence of ATP or nonhydrolyzable ATP analogues [adenosine 5'-O-(3-thiotriphosphate), adenylylmethyl-enediphosphonate (AMP-PCP), or 5'-adenylylimidodiphosphate] in the patch pipette. Sustained activation of VSOAC also required ATP. Channel rundown was observed when cellular ATP levels were lowered by intracellular dialysis with the patch pipette solution. Rundown was prevented by the ATP analogue AMP-PCP. Passive swelling-induced myo-[3H]inositol and [3H]taurine efflux was blocked by metabolic inhibitors that decreased cellular ATP levels. Titration of cellular ATP levels with azide demonstrated that the apparent dissociation constant (Kd) for ATP of both myo-inositol and taurine efflux was approximately 1.7 mM. The high Kd for ATP indicates that cellular metabolic state plays an important role in modulating organic osmolyte loss. Regulation of VSOAC activity by ATP prevents depletion of metabolically expensive organic osmolytes when cellular energy production is reduced. In addition, ATP-dependent regulation provides essential feedback to minimize the loss of energy-producing carbon sources such as pyruvate, short-chain fatty acids, ketone bodies, and amino acids, which readily permeate this channel.

Rat C6 glial cells undergo rapid regulatory volume increase (5-10 min) via electrolyte uptake when exposed to a hypertonic medium. With chronic exposure to hypertonicity (greater than 8 h), accumulated electrolyte is replaced partly by inositol. Inositol accumulation is brought about by upregulation of Na(+)-dependent inositol transport. When C6 cells acclimated chronically to hypertonic NaCl medium were returned to isotonic conditions, inositol levels dropped slowly from 478 nmol/mg protein towards control values (117 nmol/mg protein) in 18-24 h. Inositol loss occurred in part by efflux to the external medium via a pathway distinct from the uptake mechanism. Laser light-scattering measurements demonstrated that regulatory volume decrease (RVD) is slow under these experimental conditions. In contrast, cells exposed acutely to hypertonicity swell and then undergo a rapid and nearly complete RVD when returned to isotonic medium. These results suggest that slow inositol loss is rate limiting for RVD during recovery from chronic hypertonic stress. The slow inositol loss and RVD may be due to slow turnover of the efflux mechanism and/or slow downregulation of the hypertonically stimulated inositol uptake pathway.

Rumination has been persistently implicated in the etiology of hopelessness and depression, which are proximal predictors of suicidality. As a result, researchers have started to examine the role of rumination in suicidality. This systematic review provides a concise synopsis of the current progress in examining the relationship between rumination and suicidality, and highlights areas for future research. A search of the international literature was conducted using the three main psychological and medical databases. Eleven studies were identified providing evidence, with one exception, of a relationship between rumination and suicidality. This review also highlights the considerable dearth of studies on this area of concern, specifically of case-control and prospective, clinical studies, in the worldwide literature.

To examine the influence of physical activity on pediatric obesity reference data for Canada.The sample included 3527 boys and 3554 girls, 6 to 18 years of age, from the 2004 Canadian Community Health Survey: Nutrition component. The heights and weights of the participants were directly measured, and the body mass index was calculated (BMI: kg/m(2)). Physical activity levels were reported using an interviewer-administered questionnaire. Participants were divided into low and high physical activity groups, based on age-specific physical activity levels (lower and upper quartiles). BMI percentiles (25th, 50th, 75th, 85th, 95th) were generated by sex using the LMS method, separately by physical activity groups.There were only minor differences in BMI at the 25th and 50th percentiles between physical activity groups in both boys and girls. However, in boys, the low active group had somewhat higher BMI values at the 85th and 95th percentiles than the high active group after the age of 10 years. In girls, the differences in BMI across groups was similar to that of boys at the 95th percentile, but inconsistent at the other percentiles.The results suggest that screening for physical activity may be important for the development of national reference data for obesity.

Cell culture is an invaluable tool for investigation of basic biological processes. However, technical hurdles including low cell yield, poor cell differentiation and poor attachment to the growth substrate have limited the use of this tool for studies of the genetic model organism Caenorhabditis elegans. This protocol describes a method for the large-scale culture of C. elegans embryo cells. We also describe methods for in vitro RNA interference, fluorescence-activated cell sorting of embryo cells and imaging of cultured cells for patch-clamp electrophysiology studies. Developing embryos are isolated from gravid adult worms. After eggshell removal by enzymatic digestion, embryo cells are dissociated and plated onto glass substrates. Isolated cells terminally differentiate within 24 h. Analysis of gene expression patterns and cell-type frequency suggests that in vitro embryo cell cultures recapitulate the developmental characteristics of L1 larvae. Cultured embryo cells are well suited for physiological analysis as well as molecular and cell biological studies. The embryo cell isolation protocol can be completed in 5-6 h.

Because of technical hurdles, large-scale cell culture methods have not been widely exploited until recently for the study of Caenorhabditis elegans. Culturing differentiated cells from larvae and adult worms is probably not technically feasible because of difficulties in removing the animal's cuticle and dissociating cells. In contrast, large numbers of developing embryo cells can be isolated relatively easily. When placed in culture, embryo cells undergo terminal differentiation within 24 h. Cultured embryo cells have been used recently to characterize ion channel function and regulation and to determine cell specific gene expression patterns. This chapter will provide a detailed description of the methods for isolating and culturing C. elegans embryo cells.

Because of technical hurdles, large-scale cell culture methods have not been widely exploited until recently for the study of Caenorhabditis elegans. Culturing differentiated cells from larvae and adult worms is probably not technically feasible because of difficulties in removing the animal's cuticle and dissociating cells. In contrast, large numbers of developing embryo cells can be isolated relatively easily. When placed in culture, embryo cells undergo terminal differentiation within 24 h. Cultured embryo cells have been used recently to characterize ion channel function and regulation and to determine cell specific gene expression patterns. This chapter will provide a detailed description of the methods for isolating and culturing C. elegans embryo cells.

This study examined the relation between depression diagnoses and outcomes in 132 cocaine-dependent patients who were randomized to relapse prevention (RP) or standard 12-step focused group continuing care and followed for 2 years. Depressed patients attended more treatment sessions and had more cocaine-free urines during treatment than participants without depression, but they drank alcohol more frequently before treatment and during the 18-month posttreatment follow-up. Cocaine outcomes in depressed patients deteriorated to a greater degree after treatment than did cocaine outcomes in patients without depression, particularly in patients in RP who had a current depressive disorder at baseline. The best alcohol outcomes were obtained in nondepressed patients who received RP. The results suggest that extended continuing care treatment may be warranted for cocaine-dependent patients with co-occurring depressive disorders.